Paediatric orthopaedics Flashcards
What is the most common cause of hip pain?
Transient synovitis
Transient Synovitis : Definition
Self-limiting condition which is triggered by a viral infection and causes inflammation of the synovial
Transient Synovitis : Pathophysiology
- Viral infection : triggers an immune response
- Inflammation of synovial lining of the hip job
- Pain and inflammation of the unilateral hip joint
Transient Synovitis : Incidence
- Male children
- 3 years - 8 years
Transient Synovitis : Clinical features
- Preceding recent viral infection
- Unilateral hip/groin pain } develops acutely
- Limp/refusal to weight bear
- Systemically well - may have low grade fever
- Sx present for <72 hours
Transient Synovitis : Management
Self-limiting, requiring only rest and analgesia.
Slipped upper femoral epiphysis : Definition
Displacement of the femoral head, commonly seen in overweight children
Slipped upper femoral epiphysis : Pathophysiology
- Adolescence during growth spurt:
* Growth plate is a weak area where growth occurs - Increased stress on the hip joint
* Mechanical stress
* Obesity - Head of the femur slips and is displaced at the growth plate - posterior-inferiorly
Slipped upper femoral epiphysis : Risk factor
Adolescence
Mechanical stress : Obesity, Trauma
Slipped upper femoral epiphysis : Clinical features
- Acute/Chronic :
* Hip, medial thigh, knee pain - Loss of internal rotation in flexion
Slipped upper femoral epiphysis : Investigation
XR - Frog-leg views
Slipped upper femoral epiphysis : Management
Surgery : internal fixation
Septic arthritis : definition
Infection of a joint - can progress to systemic infection
Septic arthritis : Clinical features
- Joint pain : Hip, Knee and Ankle (most common)
- Limp : unable to weight bear
- Systemically unwell : High Fever, lethargy
Septic arthritis : Clinical signs
- Red, hot swollen joint
- Limited range of movement
Septic arthritis : Investigation
- Bloods : Raised WCC, ESR
- Blood cultures
- Joint aspiration : Raised WCC, for culture
Perthes disease : Definition
- Disruption of the blood supply to the femoral head
- Leading to avascular necrosis - infarction of the bone - leading to femoral head deformity
Perthes disease : Incidence
- 4-8 years old } during period of rapid growth increase
- Boys : 5x more common
Perthes disease : Clinical features
- Hip pain : progressive over few weeks
- Limp
- Stiffness and reduced range of movement
Perthes disease : Investigation
X-ray : Widening of joint space, decreased femoral head size/flattening
Perthes disease : Management
- Supportive Casts/Braces : keeps femoral head within the acetabulum
- < 6 years : Observation
- Surgical management
Most cases resolve with conservative management
Developmental dysplasia of the hip : Definition
Congential disease which occurs when the hip joint does not develop properly in infants.
Presentation : Dysplasia to complete Dislocation of the hip joint
Developmental dysplasia of the hip : Causes/Risk factors
- Female (more common)
- Breech presentation : legs in breech are extended and affect development of hip in utero
- Oligohydramnios : low level of amniotic fluid limits baby’s movement
- Genetics : Family hx
Developmental dysplasia of the hip : Clinical symptoms
- Leg length discrepancy
- Level of knees when hips + knees are bilaterally flexed
- Restricted ROM : abduction of the hip in flexion
Developmental dysplasia of the hip : Clinical signs
- Barlow test: attempts to dislocate an articulated femoral head
- Ortolani test: attempts to relocate a dislocated femoral head
Developmental dysplasia of the hip : Investigations
- Screening;
* New born check
* 6 week baby check: Barlow + Ortolani test - Ultrasound - if >5 months for X-ray
Developmental dysplasia of the hip : Management
- Spontaneously resolve by 3-6 weeks
- < 5 months : Pavllik harness
Chondromalacia patellae : Definition
Softening and degeneration of the underside of the knee cap
Chondromalacia patellae : Clinical features
- Pain :
* Surrounding or behind patella
* Up/down Stairs : anterior knee pain
* Pain around or behind knee
* Pain after prolonged knee bending - Crepitus : When moving knee
- Overuse/repetitve stress on the knee
Chondromalacia patellae : Incidence
Teenage girls
Chondromalacia patellae : Management
Physiotherapy
Osgood-Schlatter disease : Definition
- Condition affecting sporty teenagers
- Inflammation and pain at the tibial tuberosity
Osgood-Schlatter disease : Pathophysiology
1 . Tibial tuberosity
* Has a growth plate
* Patella tendon attaches to tibia
2 . Growth spurt
* Bones and tendons grow at different rate
* Increased tension on growth plate
3 . Pulling on patellar tendon on the growth plate
* Inflammation and pain
Osgood-Schlatter disease : Incidence
Athetic teenager : sports requiring flexion of the knees
Osgood-Schlatter disease : Clinical features
- Pain below patella : tender tibial tuberosity, exacerbated by activity
- Swelling and tenderness of tibial tuberosity
Patellar tendonitis : Definition
Inflammation of the patellar tendon causes by repetitive jumping/running or intense physical activity
Patellar tendonitis : Pathophysiology
- Repetitve stress on tendon without adequate recovery time
* Microscopic tears accumulate and cause inflammation
Patellar tendonitis : Clinical features
- Anterior knee pain : below kneecap, where tendon attaches to tibia
- Pain during and after activity
- Tenderness and swelling of Patella tendon
Osteochondritis dissecans : definition
Triggered by chronic activity and causes by separation of cartilage and underlying bone
Osteochondritis dissecans : Pathphysiology
- Repeated stress or trauma
- Disruption of blood supply
- Ischaemia, fragmentation and detachment
* Necrosis : segment and underlying bone can become fragmented and detach from joint surface - Loose body formation
* Detatched fragment may remains within joint
Osteochondritis dissecans : Clinical features
- Joint pain and swelling
- Joint instability : catching and locking
- Limited range of movement
Patellar subluxation : Definition
Partial dislocation of the patella from its position within the patellofemoral groove
Patellar subluxation : Incidence
Sporty children - high impact sport
Patellar subluxation :Clinical features
- Instability / locking : knee may give away
- Medial knee pain from lateral subluxation
Osteogenesis imperfecta : Definition
Autosomal dominant disorder - mutation of genes affecting synthesis of type 1 collagen
Osteogenesis imperfecta : Pathophysiology
- Bone fragility /high risk of fractures
- Collagen is in the extra cellular matrix - contributes to bone strength
- Abnormal bone formation :
- Dysfunction collagen affects bone formation
- Growth retardation
Osteogenesis imperfecta : Clincial features
- Brittle teeth
- Hypermobility
- Blue sclera : thin and translucence of the scleral tissue which is caused by collagen abnormalities
- Hearing loss : collagen is present in inner ear and abnormalities can cause hearing loss
